Written accounts of living With epilepsy or psychogenic nonepileptic seizures: A thematic comparison

This study examines the subjective experience of living with epilepsy or psychogenic nonepileptic seizures (PNES) by thematically comparing individuals' written accounts of their condition. Five key differences emerged. Theme 1: "Seizure onset" revealed differences in how individuals think about and ruminate over the possible causes of their condition. Theme 2: "Emotive tone" demonstrated that writings of those with epilepsy reflected stable emotions (no intense emotional reactions), whereas those of writers with PNES reflected anxiety and low mood. Theme 3: "Seizure symptoms" showed differences in the conceptualization of seizures. Theme 4: "Treatment" explored differences in the diagnostic journey and experiences of health care professionals. Theme 5: "Daily life" revealed that those with epilepsy perceived sequelae and seizures as something that must be fought, whereas those with PNES tended to describe their seizures as a place they enter and something that has destroyed their lives. The findings have implications for treatment and management

Screening for functional neurological disorders by questionnaire

Objective: Diagnostic screening for functional neurological disorders (FNDs) continues to pose a challenge. Simple symptom counts fail clearly to discriminate patients with FND but there is increasing recognition of ‘positive’ features which are useful diagnostically during face-to-face assessments. A self-completed questionnaire evaluating specific features of FNDs would be useful for screening purposes in clinical and research settings. Methods: The Edinburgh Neurosymptoms Questionnaire (ENS) is a 30-item survey of presence and nature of: blackouts, weakness, hemisensory syndrome, memory problems, tremor, pain, fatigue, globus, multiple medical problems, and operations constructed via literature review and expert consensus. We conducted a pilot of the ENS on new general neurology clinic attendees at a large regional neuroscience centre. Patients were grouped according to consultant neurologist impression as having symptoms that were ‘Not at all’, 'somewhat’, ’Largely’ or ’Completely’ due to a functional disorder. Results: Blackouts, weakness and memory questions provided reasonable diagnostic utility (AUROC = 0.94, 0.71, 0.74 respectively) in single symptom analysis. All other symptoms lacked discriminating features. A multivariate linear model with all symptoms predicted functional classification with moderate diagnostic utility (AUROC = 0.83), specificity of 0.97, sensitivity of 0.47. Pain and blackout scores provided the most accurate predictor of functional classification. Conclusion: The ENS questionnaire provides some utility in differentiating patients presenting with functional blackouts but failed to provide diagnostic value in other types of FND, highlighting the limitations of this self-report tool

What Does Free Space Lambda-Lambda Interaction Predict for Lambda-Lambda Hypernuclei?

Data on Lambda-Lambda hypernuclei provide a unique method to learn details on the strangeness S =-2 sector of the baryon-baryon interaction. From the free space Bonn-Julich potentials, determined from data on baryon-baryon scattering in the S=0,-1 channels, we construct an interaction in the S =-2 sector to describe the experimentally known Lambda-Lambda hypernuclei. After including short--range (Jastrow) and RPA correlations, we find masses for these Lambda-Lambda hypernuclei in a reasonable agreement with data, taking into account theoretical and experimental uncertainties. Thus, we provide a natural extension, at low energies, of the Bonn-Julich OBE potentials to the S =-2 channel.Comment: 4 pages, 2 figures, revtex4 style. Minor changes in conclusions. References updated. Accepted in Phys. Rev. Let

Developing an intelligent virtual agent to stratify people with cognitive complaints: A comparison of human-patient and intelligent virtual agent-patient interaction

Previous work on interactions in the memory clinic has shown that conversation analysis can be used to differentiate neurodegenerative dementia from functional memory disorder. Based on this work, a screening system was developed that uses a computerised 'talking head' (intelligent virtual agent) and a combination of automatic speech recognition and conversation analysis-informed programming. This system can reliably differentiate patients with functional memory disorder from those with neurodegenerative dementia by analysing the way they respond to questions from either a human doctor or the intelligent virtual agent. However, much of this computerised analysis has relied on simplistic, nonlinguistic phonetic features such as the length of pauses between talk by the two parties. To gain confidence in automation of the stratification procedure, this paper investigates whether the patients' responses to questions asked by the intelligent virtual agent are qualitatively similar to those given in response to a doctor. All the participants in this study have a clear functional memory disorder or neurodegenerative dementia diagnosis. Analyses of patients' responses to the intelligent virtual agent showed similar, diagnostically relevant sequential features to those found in responses to doctors' questions. However, since the intelligent virtual agent's questions are invariant, its use results in more consistent responses across people - regardless of diagnosis - which facilitates automatic speech recognition and makes it easier for a machine to learn patterns. Our analysis also shows why doctors do not always ask the same question in the exact same way to different patients. This sensitivity and adaptation to nuances of conversation may be interactionally helpful; for instance, altering a question may make it easier for patients to understand. While we demonstrate that some of what is said in such interactions is bound to be constructed collaboratively between doctor and patient, doctors could consider ensuring that certain, particularly important and/or relevant questions are asked in as invariant a form as possible to be better able to identify diagnostically relevant differences in patients' responses

SS-matrix poles near the ΛN\Lambda N and ΣN\Sigma N Thresholds in the Coupled \\ΛN−ΣN\Lambda N-\Sigma N System

We search $t$-matrix poles for $\Lambda N-\Sigma N$ coupling interactions using two soft core models of the Nijmegen group which bind the hypertriton at the correct binding energy, and hard core models which are still influential in hypernuclear physics. To treat the hard core potentials, a useful method for calculating the off-shell $t$-matrix is proposed. We find poles close to the $\Sigma N$ threshold in the second or third quadrant of the complex plane of the $\Sigma N$ relative momentum. The relation between the poles and the shape of the $\Lambda N$ elastic total cross section is discussed based on a so-called uniformization by which two-channel $t$-matrices become single-valued on a complex valuable. We also find poles near the $\Lambda N$ threshold. These are correlated to the $S$-wave $\Lambda N$ scattering lengths, the values of which have yet to be determined.Comment: 18 pages, 7 figures, Revte

Economic liberalization and the antecedents of top management teams: evidence from Turkish 'big' business

There has been an increased interest in the last two decades in top management teams (TMTs) of business firms. Much of the research, however, has been US-based and concerned primarily with TMT effects on organizational outcomes. The present study aims to expand this literature by examining the antecedents of top team composition in the context of macro-level economic change in a late-industrializing country. The post-1980 trade and market reforms in Turkey provided the empirical setting. Drawing upon the literatures on TMT and chief executive characteristics together with punctuated equilibrium models of change and institutional theory, the article develops the argument that which firm-level factors affect which attributes of TMT formations varies across the early and late stages of economic liberalization. Results of the empirical investigation of 71 of the largest industrial firms in Turkey broadly supported the hypotheses derived from this premise. In the early stages of economic liberalization the average age and average organizational tenure of TMTs were related to the export orientation of firms, whereas in later stages, firm performance became a major predictor of these team attributes. Educational background characteristics of teams appeared to be under stronger institutional pressures, altering in different ways in the face of macro-level change

Density dependent hadron field theory for hypernuclei

The Density Dependent Relativistic Hadron Field (DDRH) theory, previously introduced and applied to isospin nuclei, is extended to hypernuclei by including the octet hyperons. Infinite matter Dirac-Brueckner theory for octet baryons and the derivation of in-medium DDRH baryon-meson vertices is discussed. From the properties of Dirac-Brueckner interactions it is found that hyperon and nucleon self-energies and vertices are related by the ratios of free space coupling constants. This leads to simple scaling laws for the in-medium hyperon and nucleon vertices. The model is applied in relativistic DDRH mean-field calculations to singl$\Lambda nuclei. Free space N-Lambda T-matrix results are used for the scalar vertex. As the only free parameter the hyperon vector vertex scaling factor is adjusted to a selected set of hypernuclear data. Spectroscopic data of single Lambda hypernuclei over the full mass range are well described. The reduced Lambda spin-orbit splitting is reproduced and found to be related closely the medium dependence of scalar and vector interactions.Comment: 38 pages, 9 figure

The wind catcher : a passive cooling device for hot arid climate

BACKGROUND: fMRI is becoming a standard tool for the presurgical lateralization and mapping of brain areas involved in language processing. However, its within-subject reproducibility has yet to be fully explored. OBJECTIVE: To evaluate within-test and test-retest reliability of language fMRI in consecutive patients undergoing evaluation for epilepsy surgery. METHODS: Thirty-four unselected patients were investigated once (within-test reliability) and 12 patients twice (test-retest reliability). The imaging series consisted of an alternating 25-second synonym judgment condition with a 25-second letter-matching condition repeated 15 times. Reproducibility of activation maps of the first and second half of session 1 or activation maps of sessions 1 and 2 was evaluated by comparing one global and three regional lateralization indexes (Broca's area, remaining prefrontal cortex, temporoparietal area) and on a voxel-by-voxel basis (intraclass correlation coefficient, percentage overlap, correlation of t-values). RESULTS: Global and regional language lateralization was achieved with high reliability within and across sessions. Reproducibility was evenly distributed across both hemispheres but not within each hemisphere. Frontal activations were more reliable than temporoparietal ones. Depending on the statistical threshold chosen, the voxel-by-voxel analysis revealed a mean overlap of activations derived from the first and second investigation of up to 48.9%. CONCLUSION: Language fMRI proved sufficiently reliable for the determination of global and regional lateralization of language representation in individual unselected patients with epilepsy

Application of the density dependent hadron field theory to neutron star matter

The density dependent hadron field (DDRH) theory, previously applied to isospin nuclei and hypernuclei is used to describe $\beta$-stable matter and neutron stars under consideration of the complete baryon octet. The meson-hyperon vertices are derived from Dirac-Brueckner calculations of nuclear matter and extended to hyperons. We examine properties of density dependent interactions derived from the Bonn A and from the Groningen NN potential as well as phenomenological interactions. The consistent treatment of the density dependence introduces rearrangement terms in the expression for the baryon chemical potential. This leads to a more complex condition for the $\beta$-equilibrium compared to standard relativistic mean field (RMF) approaches. We find a strong dependence of the equation of state and the particle distribution on the choice of the vertex density dependence. Results for neutron star masses and radii are presented. We find a good agreement with other models for the maximum mass. Radii are smaller compared to RMF models and indicate a closer agreement with results of non-relativistic Brueckner calculations.Comment: 28 pages, 11 figure

Cognitive–behavioural therapy compared with standardised medical care for adults with dissociative non-epileptic seizures: the CODES RCT

Background Dissociative (non-epileptic) seizures are potentially treatable by psychotherapeutic interventions; however, the evidence for this is limited. Objectives To evaluate the clinical effectiveness and cost-effectiveness of dissociative seizure-specific cognitive–behavioural therapy for adults with dissociative seizures. Design This was a pragmatic, multicentre, parallel-arm, mixed-methods randomised controlled trial. Setting This took place in 27 UK-based neurology/epilepsy services, 17 liaison psychiatry/neuropsychiatry services and 18 cognitive–behavioural therapy services. Participants Adults with dissociative seizures in the previous 8 weeks and no epileptic seizures in the previous year and meeting other eligibility criteria were recruited to a screening phase from neurology/epilepsy services between October 2014 and February 2017. After psychiatric assessment around 3 months later, eligible and interested participants were randomised between January 2015 and May 2017. Interventions Standardised medical care consisted of input from neurologists and psychiatrists who were given guidance regarding diagnosis delivery and management; they provided patients with information booklets. The intervention consisted of 12 dissociative seizure-specific cognitive–behavioural therapy 1-hour sessions (plus one booster session) that were delivered by trained therapists, in addition to standardised medical care. Main outcome measures The primary outcome was monthly seizure frequency at 12 months post randomisation. The secondary outcomes were aspects of seizure occurrence, quality of life, mood, anxiety, distress, symptoms, psychosocial functioning, clinical global change, satisfaction with treatment, quality-adjusted life-years, costs and cost-effectiveness. Results In total, 698 patients were screened and 368 were randomised (standardised medical care alone, n = 182; and cognitive–behavioural therapy plus standardised medical care, n = 186). Primary outcome data were obtained for 85% of participants. An intention-to-treat analysis with multivariate imputation by chained equations revealed no significant between-group difference in dissociative seizure frequency at 12 months [standardised medical care: median of seven dissociative seizures (interquartile range 1–35 dissociative seizures); cognitive–behavioural therapy and standardised medical care: median of four dissociative seizures (interquartile range 0–20 dissociative seizures); incidence rate ratio 0.78, 95% confidence interval 0.56 to 1.09; p = 0.144]. Of the 16 secondary outcomes analysed, nine were significantly better in the arm receiving cognitive–behavioural therapy at a p-value < 0.05, including the following at a p-value ≤ 0.001: the longest dissociative seizure-free period in months 7–12 inclusive post randomisation (incidence rate ratio 1.64, 95% confidence interval 1.22 to 2.20; p = 0.001); better psychosocial functioning (Work and Social Adjustment Scale, standardised treatment effect –0.39, 95% confidence interval –0.61 to –0.18; p < 0.001); greater self-rated and clinician-rated clinical improvement (self-rated: standardised treatment effect 0.39, 95% confidence interval 0.16 to 0.62; p = 0.001; clinician rated: standardised treatment effect 0.37, 95% confidence interval 0.17 to 0.57; p < 0.001); and satisfaction with treatment (standardised treatment effect 0.50, 95% confidence interval 0.27 to 0.73; p < 0.001). Rates of adverse events were similar across arms. Cognitive–behavioural therapy plus standardised medical care produced 0.0152 more quality-adjusted life-years (95% confidence interval –0.0106 to 0.0392 quality-adjusted life-years) than standardised medical care alone. The incremental cost-effectiveness ratio (cost per quality-adjusted life-year) for cognitive–behavioural therapy plus standardised medical care versus standardised medical care alone based on the EuroQol-5 Dimensions, five-level version, and imputed data was £120,658. In sensitivity analyses, incremental cost-effectiveness ratios ranged between £85,724 and £206,067. Qualitative and quantitative process evaluations highlighted useful study components, the importance of clinical experience in treating patients with dissociative seizures and potential benefits of our multidisciplinary care pathway. Limitations Unlike outcome assessors, participants and clinicians were not blinded to the interventions. Conclusions There was no significant additional benefit of dissociative seizure-specific cognitive–behavioural therapy in reducing dissociative seizure frequency, and cost-effectiveness over standardised medical care was low. However, this large, adequately powered, multicentre randomised controlled trial highlights benefits of adjunctive dissociative seizure-specific cognitive–behavioural therapy for several clinical outcomes, with no evidence of greater harm from dissociative seizure-specific cognitive–behavioural therapy. Future work Examination of moderators and mediators of outcome. Trial registration Current Controlled Trials ISRCTN05681227 and ClinicalTrials.gov NCT02325544. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 43. See the NIHR Journals Library website for further project information